Sometimes the best treatment is none at all.

User

Posted 20 Nov 2025 at 00:00

I have been weighing up my options carefully over the last couple of years since my BCR was confirmed. My doubling time was slow (18 months) and I only had 2 active pelvic nodes. So I had SRT which resulted in a 30% drop in my PSA to 2.4ng/ml after 3 months. A bit early to be definitive of course but encouraging. Unfortunately subsequent PSA testing at six post TX showed the PSA dip was a blip as my PSA had returned to pre treatment levels. So what to do if anything?

For clarification I am 75 years, my health status is poor, with a multitude of comorbidity, the most salient of which is heart failure. Following a discussion with my Radiation Oncologist yesterday we have decided on a softly softly approach to try to maintain a reasonable quality of life while I am able to. To that end it we have decided against the usual first and second line treatements. The rationale being that flair in my heart failure would be guaranteed. Thus our plan of action is PSA monitoring every 3/12. A CT and perhaps a Bone Scan looking for new lesions in a year's time. Any new lesions found to be treated by another dose of SRT. So that is where I am currently at.

The reason for my post is to make people aware that comorbidity can have an impact far in excess of PCa. If my assumptions are incorrect and my PCa does matamorphosis from a kitten in to a raging tiger, I do have the assisted dying protocol which is available now in all states of Australia. I just recently observed the assisted dying protocol with an old friend who died with a smile on his face, following his dog licking his hand. It was a dignified end to a good life.

I am happy to answer genuine questions.

Edited by moderator 20 Nov 2025 at 12:29 | Reason: Thanks for your post. We appreciate you sharing your experience. We’ve approved it but removed the l

User

Posted 02 Jan 2026 at 23:07

Well just when I thought my journey was all organised my most recent PSA has decided to head south again by the same 30% margin? Well while most welcomed, this has my physicians and myself somewhat dumbfounded. A see saw pattern seems to be emerging every six weeks. So it would appear that my BCR is neither progressing nor regressing at this stage. The catalyst? No idea, as the therapies for my co-morbidities have remained static. Stress? Well I really don't have any. I am quite comfortable with where I am on my journey. TBC.

User

Posted 03 Jan 2026 at 03:36

Your PCa seems to be taking an unusual path but you have thought things through and as you say if it gets get really bad, you have the enlightened assisted dying in OZ. Unfortunately, in the UK Parliament has talked a lot about it then it gets put on the back burner like so many other questions they don't want to answer. My wife died of dementia, pneumonia and starvation last year, When I visited her in the care home I could hear her screaming before I even got to her room. This continued throughout my visit and after I left until exhausted she fell asleep. Had assisted dying been provided in the UK, she would have not have had to endure several weeks of pain and anguish. PCa can also be a rotten death and whether it's because of this or something else, I hope the Bill will be enacted here soon.

Barry

User

Posted 18 Jan 2026 at 23:24

Hi jfd

Can I ask what specific treatment you were advised would flare up your heart failure?

My dad is in a similar situation to you where he has multiple health issues, one of which is heart failure. He was prescribed Zoladex 12 months ago and since then he’s been admitted in hospital twice for fluid on his lungs which he had never experienced before starting Zoladex. He’s now rapidly declined and barely has the energy to get out of bed and we are wondering if this is being made worse by the Zoladex.

We don’t seem to have had as good advice as you regarding the heart failure and due to the multiple health issues we are just getting passed round in circles.

Any advice you could give would be much appreciated, thanks Lucy

User

Posted 22 Jan 2026 at 06:27

Reply to Old Barry,

Barry in all states of Australia assisted dying is only available to persons able to make an informed decision about ending their life. Dementia would be a red flag I am afraid. The other proviso is that the person has received medical advice to the effect that their lifespan is of six months or less. However the time frame is extended to 12 months for MND and subsets.

The person if possible ingests the Pentobarbital orally. If that is not possible either a Medical Practitioner or a Nurse Practitioner may administer the lethal dose intravenously.

I am due for a further PSA test in a few weeks (6 weekly intervals for the present) and we shall see if we have stability or another rise.

Edited by member 22 Jan 2026 at 06:55 | Reason: Not specified

User

Posted 22 Jan 2026 at 06:51

Reply to Lucy29

Hello Lucy,

The usage of ADT has been contraindicated in PCa patients with heart failure for a good period of time. General consensus is of the view that ADT in it's various forms may give rise to the development of heart failure in some individuals. So while the risk is known, treating physicians tend to try to balance treatment on the basis of dealing with the most life threatening co-morbidy. If PCa is rampant and heart failure in stage 1 or 2, then ADT may be considered appropriate and conversely visa versa as in my case.

Forgive me Lucy, but I am trying to simplify what is a very complex medical situation. I think you should have a good chat with your Dad's physician.

Edited by member 22 Jan 2026 at 06:59 | Reason: Not specified

User

Posted 17 Feb 2026 at 04:42

Well my six weekly psa see saw pattern continues. When I reached BCR back in March 2024 my psa was at 2.4 ng/ml. By October that year my psa was 3.2 ng/ml. In February of 2025 it had again risen to 3.55 ng/ml. In March when I had a Radiation Oncology consult, the pas value was 3.61 ng/ml. At that time I was treated by SRT to two pelvic lymph nodes that had been previously identified by a PET Scan. Following the SRT treatment in July 2025 was PSA dropped to 2.76 ng/ml. By November my psa increased again to about the pre treatment level of 3.40 ng/ml. In December of 2025 my psa again dropped to 2.77 ng/ml. February 2026 and my psa again returned to pre treatment level, 3.35 ng/ml. So while the spikes are interesting, essentially they are of of no significance clinically at the present point of time. But is is heartening to know that my psa presently appears to be in a circular orbit holding pattern. The Lancet of 16th of Feb 2026 has an article on developing a nomogram for men in my situation. So maybe a useful tool may be forthcoming in the future.

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00717-X/abstract?rss=yes

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